The words used in the headline falls into the ‘unhelpful’ category. The article actually includes the experiences of three people: one an advocate for home birth; a mum who chose to give birth in a hospital; and a dad whose wife chose a home birth for their fourth child – there were complications and he advocates choice. In short, the article really says “different women choose different places to give birth for different reasons”.

Articles such as this are all as a result of new NICE guidelines that suggest 45% of births are more suitable for midwife-led care or home birth. Difficulties with healthcare communication and such headlines can arise when words such as ‘are’ and ‘is’ are used. Yes, the guidelines are based on evidence, but when you say ‘are’ and ‘is’, people tend to interpret that as a blanket fact. ‘Could be’ is better than ‘are’ because each woman is an individual, with her own individual needs.

Some commentators are concerned the guidelines could remove choice, rather than giving more, worrying that ‘encouraging’ women to give birth at home is a euphemism for ‘forcing’ them to do so.

This example demonstrates that whenever a new guideline on any health matter is released, it will be met with a healthy dose of cognitive dissonance – people interpreting the news based on their own experiences, expectations, hopes and fears.

Cognitive dissonance happens even if you have evidence for your new guidance coming out of your ears. As an NHS communications manager, countless hours of my life have been spent translating NHS guidance on a range of matters – cancer screening, vaccinations and healthy lifestyles to name just a few – into something that the public can understand, relate to – and hopefully act on.

When writing a press release on a health matter, or a patient information leaflet great caution has to be taken to not over-generalise, raise unrealistic expectations, or be misinterpreted by the media (although with the best will in the world the latter is not always possible).

I understand that years of scare stories about all forms of birth have led to a crippling fear of birth. Balance is what is needed. When talking about home birth or midwife-led care being a safe or a safer (than hospital) option for a certain group of women, we should be careful to emphasise those options are not safe or safer than a hospital birth for every woman. A lack of that emphasis could have the unintended consequence of making women who have to give birth in hospital, or need to have interventions for whatever reason feel less of a woman, or to have failed, or to feel guilty.

Surely none of us want that.

I know a couple of women who have given birth by Caesarean section, both emergency and elective. They said they have had comments from women who have delivered their babies naturally such as women who have had C-sections ‘haven’t really given birth’. What a horrible thing to say! I had an emergency C-section myself, and while I have little doubt pushing a baby out of your vagina hurts (a lot, probably), having your stomach muscles cut open is far from an easy option.

Yes, we need to stop fear of birth. Yes, we need to promote birth as a normal life event. But we should be careful to not encourage or perpetuate bitchiness and competition between women as another unintended consequence of these messages.

This is the kind of statement about birth that I would love to read:

“Individual women have individual needs when giving birth. Many women are able to give birth at home, but because of issues with the current system not all who want to choose a home birth get it. Hospital can be a stressful place to give birth, which can lead to some women having interventions that are unnecessary. That’s why we’d like to give more women, in joint discussion with them, the option to give birth at home if they are considered to be low-risk. However, the needs of mums and babies are paramount, and as birth is not always straightforward there may be mums who need to give birth in hospital, with or without intervention.

“Our ultimate aim is for every woman’s experience of birth to be positive. We will do that by empowering women to be able to voice their opinions, have as many options as possible, and strive to remove fear and guilt by saying there is no right way or place to give birth.”

I know my fantasy statement above is what the guidelines are trying to achieve – this statement from NICE sort of says the same thing.

The trouble is, some people will be literal and translate the key point into ‘they’re saying home birth is safer, that means hospital birth must be dangerous’. This isn’t helped by headlines such as this one from The Mirror: “Mums-to-be warned: ‘Have your baby at home, it’s safer'”.

Many people are too busy to delve in to the facts behind the story (or just can’t be bothered to look). That results in a perception that the guidelines are saying something like:

“Home is the safest place to have your baby! Good luck to you if you have to give birth in hospital. They’re scary places, staffed by evil obstetricians whose greatest pleasure comes from inflicting pain by doing things to you that you don’t need.”

Ergo, more fear is created by stigmatising hospital birth. We don’t want such a vicious circle. So, balance. When talking about birth, think about helpful and unhelpful words, how they might be interpreted and their consequences.

We also need a greater emphasis on patient feedback, so services know what to focus on. Happily, more hospitals throughout the NHS are doing this.

As well as listening to negative experiences so services can improved, we need also need to promote the positive experiences – fear not, there are plenty of them, wherever the mum gives birth, and however the baby comes out.

Note: I called the statement a ‘fantasy’ for sake of the avoidance of doubt that it’s not an official statement.

*Amendment: thanks to the cut and paste gremlins, the paragraph beginning “The trouble is…” was omitted from the original version.

14 thoughts on “The importance of balanced messages when talking about birth”

I think it’s important for women to have a choice and to feel supported in that choice. For my last pregnancy I was aware that I was high risk and that I need to be in s hospital setting. I’m not sure that had it been my first I would have wanted to be at home anyway. But what happened this time is that all of my decisions for Elsie’s birth were made for me and without discussion. I wanted s vbac and was pretty much laughed at. Then iugr cropped up and the vbac was out of the question but had my wishes been consirered a little more carefully I do think my recovery would have been different.

Fab post, as always and thank you for liking up to #MaternityMatters x x x

Having experienced a MWLU birth with complications afterwards, and then a beautiful, calming, healing water birth on a delivery suite (even though that came with serious complications post-delivery) I hate this ‘one size fits all’ approach to delivery. Every pregnant woman should be supported to choose where to give birth with the advice of medical professionals. I would have loved the opportunity to have a home birth but my history precludes me. from it and I don’t think I would ever have been able to persuade my partner that it was a good idea.

The headlines are lazy and scary, using words like ‘shun’ and ‘safe’ will create confusion and fear in pregnant women.

I couldn’t agree more, women should have the choice to give birth wherever is best for them – there is never going to be a ‘once size fits all’. And I can’t stand such negative language either – creating fear and confusion is far from helpful! Thanks for commenting xxx

Abso-blinking-lutely. There’s a big difference between “encouraging pregnant women to shun labour wards” and making the choices, options and risks more clear and accessible and encouraging women to make active and informed decisions about their births. As soon as anyone asks me about my birth plan and I utter the words home birth I am abruptly cut off with “oh no they won’t let you for a first baby”, because apparently all pregnant women are in exactly the same risky bound-for-the-hospital boat first time around. That is still the belief and I have only been looked at like I’m not mad to want a home birth by people aged over 60 so far.

As an example of lazy interpretation, I posted a link to one of the recent articles on home births and was promptly sent one back quoting a local consultant on why “Homebirths are ‘definitely not a safer option for first time mothers'”. What I interpreted it as, was that women shouldn’t be advised TO deliver at home, rather than that women should be advised against delivering at home. A key but subtle difference.

All in all buzzwords and media spin to get clicks and reactions are socially irresponsible at the best of times. This is no matter to play around with either, and it angers be that the potential consequences don’t seem to matter at all.

Yes – I completely understand that the media go for impactful headlines, but there needs to be so much more thought about the impact of that, especially with such important issues. Agree about lazy interpretations – the nuances between advising to/against something are key, but too often missed, and that’s when the misconceptions get out of control. Thanks for commenting xxx

All so true Leigh,
I absolutely support making home birth and especially midwife led units (which is what NICE was actually suggesting as the best option for most low risk women) available to all who want them and if people are unduly scared of these options then they need to be given the best information to combat that. BUT this absolutely should not be done by making hospital seem terrifying and if there are problems in hospitals then those need to be addressed for the benefit of all those women who do want or need to be there, not just ignored because others can be at home instead.

Where I live you also get much much better midwife care before, during and after birth if you opt for a homebirth, for complicated reasons I was lucky enough to have access to this for my second baby (even though she was born by planned c-section!) and wow it makes such a difference. We need to be sure that the choice is home v hospital not good care v bad

I couldn’t agree more with your final sentence, which I think succinctly sums up the post “We need to make sure that the choice is home v hospital not good care v bad”. Misconceptions and misperceptions are so unhelpful to everyone. We need openness about the whole picture of choice and options, not individual options selected and highlighted and picked apart. Thanks for commenting xxx

Thanks, Tara. I think the ‘fantasy’ statement is something everyone wants, the trouble is the birth debate gets picked apart with various bits focused on at a time, very rarely do we see the whole picture presented in one place at one time xxx